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103 Cards in this Set
- Front
- Back
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How do we classify burns in prehospital setting?
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by the
Location Depth Surface Area Cause |
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Describe a superficial burn
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Top portion of epidermis
Skin is pink/red & blanches Skin heals within 3-7 days No permanent scarring can be very painful |
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Describe a partial burn
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Epidermis and part of dermis
Skin pink-red w moderate oedema Blisters present Adnexal struct involved, but basal layers can regrow Extremly painful, nerve endings exposed Can heal w 10-21 days |
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Describe a full thickness burn
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Entire epidermis and dermis
Adnexal structs destroyed, skin cannot regenerate skin is leathery, white or charred Require skin grafts nerve endings and bv destroyed |
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How do we calculate the SA of the burn?
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Using the wallace rule of nines i pre hosp and the lund browder in hosp espec for paeds
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What burns are classified as major burns?
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Partial/Full thickness with:
-BSA >10% in <10 or >50 yo's -BSA >25% in any ages -Threat of fnal/cosmetic to face, hands, feet, genitalia -full thickness > 5% |
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More major burns
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-Electrical burns,incl lightening
-Chemical burns w fnal/csm threat -Inhalational burns -Circumferencial burns to limbs/chest |
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2 more major burns
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-Burns pt w pre existing medical prblem that could complicate recovery/treatment
-Any burns pt with trauma |
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Describe Thermal burns
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Most common, highest risk in 18-35 yo
high incidence of scalding in 1-5 yo Soft tissue burnt w exposed to 45 degrees necrosis x2 w every > of 1* |
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What does thermal burns do to tissue?
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Causes coagulation of soft tissue, cap perm >, Oedema begins, Microemboli form from viscus plasma
fluid loss ?=> shock, hypoval burns can > metab rate |
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What are the 3 zones of injry in thermal burns?
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Zone 1: Zone of coagulation
-centre of wound,most intense point of contact -tissue is coagulated and cells necrosed |
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Zone 2
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Zone of stasis.
-surr critically inj area -potentialy viable -the ischemic cells here will die within 24-48 hrs |
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Zone 3
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Zone of hyperemia
-endge of wound -cells still alive ->bld flow due to infalmmn -recover w 7-10 days if no inffection begins |
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What happens to circulation as a result of a burn?
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increased evaporation=
possible burn shock can occur: < CO, <Venous Return, > Vasc resistance eventually:hemolysis, rhabdo,myoglobin urea,ARF, death |
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How do we treat thermal burns?
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DANGERS- be safe!!
prim survey, VSS, sec survey remove clothing, jewellery ect cool for at least 20 mins,watch hypothermia tho burns dressing pain relief, o2,salbut if wheeze, fliuds if need |
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How are fliuds administered to burns patients?
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Via the Parkland rule
= 4ml/kg * %BSA. Over 24 hrs, with half given in first 8 hrs |
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When would you suspect airway burns?
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When patient has:
hoarse voice burns to face/lips/head wheeze/ stridor odema to face/airway carbonaceous sputum obvious resp distress |
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What is special about airway burns?
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They account for most mortality in burns victims
they can take up to 24 hours for symptoms to be displayed |
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Chemical burns, acids v alkalis
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Acids cause coagulation necrosis
Alkalis cuase liqufication necrosis, alkalis can also cause burns that look superficial, but spread to full thickness |
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How do we treat chemical burns?
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Brush away as much of chemical as you can
copious irrigation pain relief (dont put water on Ca,Mg,Li) |
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Electrical burns, what are the 3 risk groups?
What is severity related to? |
Kids, teenagers and electrical workers.
Current type, volts, intensity, resistance, area and durn |
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What does an electrical burn result in?
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Contact burns, thermal heating,
flash arc and flame thermal burns. Low voltage:muscle tetany, > contact High voltage:single violent contraction, person thrown |
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What are the 5 types of contact with an electrical burn?
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Direct, side flash, contact, ground current, step potential.
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Treatment of electrical burns?
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Same as thermal,
but add monitor IV fluids 20ml/kg bolus musc relaxant? watch for devel rhabdo |
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What are some complications of all burns?
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Dehydration
infection/sepsis/tetanus temp control issues Scarring Arrythmia, heart failure pneumonia, shock, renal &liver failure |
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ENVIRONMENTAL EMERGENCIES
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Dehydration, hypothermia, hyperthemia, frostbite
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What are the four mechanisms of heat transfer?
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Radiation, conduction, convection and evaporation
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How is our temperature regulated?
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by the thermoregulation centre in the hypothalamus. there is a heat loss centre and a heat promoting centre
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What are heat promoting activities?
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Vasoconstrn, >metab, >shivering, behaviour modification
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What are heat loss activities?
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Heat promoting centre is inhibited, heat loss centre activated
vasodilation, sweating, behaviour modification |
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What is fever? Why is it important?
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it is controlled hyperthermia.
pyrogens act on hypothal to cause rel of prostaglandins, > hypothal thermostat protective mechanism to increase healing and stop bacteria. |
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Hyperthermia: what are the three types?
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heat cramps, heat exhaustion and heat stroke
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Heat cramps, describe?
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sever intermittent pain, faint, dizzy, weak, hot, sweaty, tachyc
treat by removing from heat, give cool drinks |
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Heat exhaustion?
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>in CBT: 38-40 degrees
ACS, postural hypot,dizzy, n/v, lethargey, cool pale clammy, rapid rr treat:remove from heat, assist cooling, fliuds(oral) |
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Heat stroke?
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SEVERE. can suffer NS dysfn
no thermoregn. tachyc/p, hot dry skin,cns dysnf,coma, seizure,coagulopathy, APO many complications:ARF,ARDS,DIC, rhabdo. treat:activly cool,o2,transport, dont shiver |
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What are the mechanisms that could cause hypothermia?
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< heat production(hypoglyc, malnutrition)
inapprop heat regn(cns disease, poison) > heat loss(cold exposure) < activity (elderly) |
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What is the process of hypothermia?
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bw 37-35:shivering,numb,clumsy <mental processing(34:compensation stops here.ie >RR,HR,BP stop)
33-30:drowsy, shiver stops, rigid, blue, hallcinate 29:unconc 23:heart stops |
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How do we manage a hypothermic patient?
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if no pulse just ventilate 6-8/min, NO CPR(<mvt or get VT)
warmd o2 if poss, posn on back, wrap up, provde hot env, warm fluids(dextrose) transport! |
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Frostbite, process?
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get in freezing, wet, windy env
skin red inflamed=>grey wax like pain, numbness,stinging,blisters blackening of skin remove from cold,ensure good circn, hot sweet drinks, pain relief |
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Barotrauma: what is it?
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The compression or expansion of gases in the body when the pressure in body differs from ambient environment.
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Barotrauma of descent
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Air trapped in non collapsable containers in compressed:vacume type effect.
causes sharp pain, blocked nasal tubes,headace,vertigo,SOB, nose/ear bld. |
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Barotrauma of Ascent
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As diver ascends, gas trapped in tissues/bld, it cant escape, so expands in tissues.
get POPS:alveoli rupture subcutaneous emphys, pneumoth, pneumocardium, pneumoperitoeum |
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Air embolism
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Suspect in anyone who goes unconc after diving! air gets trapped in small cicrn causing vertigo, confusion, visual dist, LOC (smiliar in presentn to stroke)
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Decompression sickness
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nitrgoen bubbles forming in bld as diver ascends.s/s presnt 6-48 hrs following dive.
s/s:pain, neuro dysfn, ACS magmt:O2 IV if need, pain relief ?, transp for hyperbraic treamnt |
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Nitrogen narcosis
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N dissolves in bld at depth and crosses BBB. has depressive effect,effects all divers, experience helps cope.
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Altitude illness
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due to different partial pressure of o2
=hypobaric hypoxia |
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what is the pathopys of hypobaric hypoxia?
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Increase in cerebral bf, causes increas in cerbral capil pressure, > capill permeab leads to CEREBRAL ODEMA
also stims SNS response(>fluid) |
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Acute Mountain Sickness AMS
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Ascending too rapidly,devel w 4-6 hrs. abates after 3-4 days
s/s lightheaded, SOB, tachyc, hypot, 'hangover', ataxia, > RR due to hypoxia |
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High Altitude Pulmonary Oedema
HAPO |
Most lethal.
s/s dry cough, tachyc/p, cyanosed,weak, rales =>ACS, coma, death treat w 100% o2, descent, hyperbaric treatment |
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High Altitude Cerebral odema HACO
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Is extreme progression of AMS, leads to increase of ICP
s/s:ACS=> coma Mgmt: 100% o2, descent |
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Hyperbraic therapy
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Increases partial pressure of 02 and pressure of 'air'.
for:severe bld loss anaemia :crush inj/ compartment syndr :decomp sickness |
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effects of hyperbaric treament
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increases o2 into tissues,
can help with AMI, CVA, musc neuro disease |
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Toxicology
Iron poisoning |
very corrosive to GIT
vomiting diarrhea abdo pain ulceration GI bleeding |
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What are the five stages in iron poisoning?
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Stage 1:direct irritation of GI
n/v, abdo pain, diahrrea Stage 2: 6-12 hrs after: feel 'better' metabolic abnormalities still present |
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Stage 3 and 4
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Stage 3: Metabolic acidosis
shock, acidosis, coagulopathy, liver dysfn Stage 4:2-5 days after possible liver failure |
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Stage 5:
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Scarring of GIT, stomach and intestine are effected.
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Treatment of iron poisoning
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O2, monitor, 2 IV, Hartmanns 20ml/kg and maxalon
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Hdrocarbons
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Pulmonary toxicity, CNS toxicity, demylination of nerves, blood, heart and skin toxicity
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Organophosphate posioning
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pesticides, absorbed, inhaled, ingested. OPs work on inhibiting AChE, so there is an increase in ACh in nerve synapses.
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Signs and symptoms
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Muscarinic and nicotinic overstimulation.
=slud, GI cramps, n/v, bronchospasm, bradycardia blurred vision, ACS, dizzy, seizure, hypot |
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Management:
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decontaminate-remove everything, poisoning will continue if not alert ED
DRABC etc Iv access ATROPINE 1.2mg every 5 mins |
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Pyrethrin
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'safest insecticide'
allergic response common |
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Rhodenticides
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many types, eg superwarfarins
s/s:lactic acidosis, n/v, GI heam, pain, parenthesias,wkness, tremor, seizure |
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Cyanide
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stops ATP production, metabolic acidosis.
mucous membr irritatn, anxiety, headache, dyspnea, confusion, seizure, coma, death red skin |
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Managemnt of Cyanide poisoning
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DRABC, 100% o2, decontaminate monitor, iv hartmanns, transport and notify
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Paracetamol
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produces a toxic byproduct that kills liver cells
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Codine
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chemically rel to morhpine
:ACS, <GCS, < airway mechs S/S n/v, drowzy, < resp, pinpoint pupils, hypot |
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Cough syrup
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> doses cause narcotic overdose
resp <, ACS, drowsy |
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Decongestants
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induce vasoconstrn by stimuln of alpha receps
s/s hypert, headache, resp distress, insomnia, agiation, tachyc |
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NSAIDs
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Increase GI bleeding and renal failure
S/S: n/v, abdo pain, CNS changes, seizure? hypot? |
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Aspirin
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salicylate, toxicity deps on cellular concentrn
causes resp alkalosis, > catabolism, metab acidosis |
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Tricyclic antidepressents
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relate to antmuscarinic and antihistamine effects
S/S: drowsy, ataxic, ECG changes, APO, aspirn pneum, hyperthermia, rhabdo drug of choice to treat: sodium bic |
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Envenomation notes.
what is the main actions of venom? |
To paralyze prey
by: interfering with neuronal conduction, junction transmissionm muscular contractions |
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Australian snakes
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Elapids, use the lymphatic system to distribute their venom
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What is in venom?
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Prothrombin aciviting enzymes which produce thrombin
peptides that block skel muscl ach channels |
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What are the effects of venom?
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Haemotoxic
Myotoxic Neurotoxic Haemolytic |
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what effects does elapid venom have on blood?
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Can inhibit plasmin that degrades fibrin; can cause DIC
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S/S
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bite site us painless
not always teeth marks, can be scratches bruising, bleeding, swelling |
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when should you consider snake bite
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unexpextd confusion/LOC after outdoor activites
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more s/s?
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Cardiac depression
paralysis DIC/coagulopathy? ?haematuria, haematemesis(20% victims have cerebral haemorr) |
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How do S/S progress?
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Highly variable
headache, n/v, confn, diarrhea, coaguln paralysis, pain, hypert, tachyc resp failure, circ failure |
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How can you treat snake bite?
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lymph system transports venom
firm bandage and immoblisn will < flow of venom can get venom detection kits to det what anitvenom to use |
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Blue bottle jellyfish
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sharp instant pain, becomes violent aching pain
possible headache, vomiting, abdo cramps, ACS, collapse |
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Mgmt:
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remover tentacles, use cold water and ice packs
apply lignocaine cream(use penthrane/morph if need) |
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Box jellyfish, how do they sting and whats in their toxin?
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Most dangerous.
tentacles covered with nematocytes, discharge toxins into skin toxin:haemolytic, cardiotoxic,dermanecrotic |
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What does the toxin do to you?
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heart becomes stuck in systole, bradycardia may devel, respir arest, bp changes, musc contrn, haemolytic
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what are the S/S?
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immediate pain,
tentacles may stick to skin weals devel,infalm, and oedematous if severe:hypot, dysryth, apnoea |
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Magmt:
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remover from water
pour vinegar on to inactivate tentacles DONT PRESSURE IMMOBLISE |
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Blue ringed octopus, what does their saliva contain?
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different toxins that can:
block neuromuscular transmission, cause < bp |
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S/s?
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Weakness, numbness around face and neck
difficulty breathing N/v +/- bradyc, hypot can progress to ACS, ataxia |
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Mgmt blue ringed octopus?
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pressure immob
O2 pain relief if need rapid transport |
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stingray
s/s? |
puncture/lacs, pain increases over time,
wound will bleed, then turns blue/white colour n/v, sweating, musc cramps, poss ACS, seizure infection is common complic |
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mgmt?
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control haemrr. pain relief(topical is best)
transport |
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Stone fish, effects of venom?
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most dangerous venomous fish
< of CV and Nueromusc syst, direct effect on muscle fn haemolysis, > vasc permeab treat: warm water, no press/immb |
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S/S?
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immediate pain that > & travels
swelling severe mucs wkness cyanosis/hypoxia shock, hypot ACS, siezure, coma |
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Sea snakes, what does the venom do?
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painless bite
causing periph paralysis, musc necrosis doesnt effect blood |
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S/S?
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euphoria, malaise, anxiety
flaccid/spastic paralysis |
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Sea urchins, what does the venom do?
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causes an anaphlyactic type response, ie < bp, swelling, < respir, rash, sweating, tachy
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S/S?
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swelling, odema, rash
burning pain bluish tinge to area n/v, wkness, hypot |
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Manage?
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o2 pain relief(-but dont want vasodiln)
pressure immob, +/- adenaline to help w hypot |
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Cone shells S/S?
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swelling, burning, small wound, bruises fast
numbness, nausea Malaise, wkness, ACS, SOB |
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Spiders, venom effects?
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nuerotoxic, CV effects, pulm odema, metabolic acidosis, hyperthermia
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Gen S/S?
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n/v, pain, swelling, odema,
sweaing, lacrimation dyspnea ACS, paralysis, tachyc |
